Celiac Disease – What’s behind the “gluten-free” craze?

As time passes, so do health food trends.  During the past twenty years, fads have ranged from the grapefruit diet, to low-fat regimens, to the Atkins no-carb craze, to the Mediterranean lifestyle, to the organic/raw/local movement.  Today, cake mixes, cereals, pasta, salad dressings, and many other food products and restaurant chains have replaced the popular “Fat Free” or “Low Carb” logos with “Gluten Free”.  So, why has consumer focus shifted to gluten, the protein found in wheat, rye, and barley that makes our bread chewy?

One likely reason is the increasing diagnosis of celiac disease.  With an estimated 1% of the population suspected to have celiac disease, it has become the most common autoimmune disorder in theUnited States.  While there is somewhat of a genetic link, this disease can affect all ages, races, and genders.

In individuals with celiac disease, the gluten found in wheat, rye, barley, and possibly oats causes their body to over-react, leading to inflammation and injury to the intestines.  Diagnosis is difficult because only about half of patients suffer from digestion problems.  Other nondescript symptoms often occur, such as fatigue, irritability, depression, behavioral problems in children, malnutrition, anemia, alopecia (balding), decreased bone density, decreased levels of essential vitamins and minerals (Vitamins D, A, K, E, calcium, iron), and infertility.  As a result of these vague symptoms, many people go undiagnosed and are not treated.  Without treatment, patients will likely report “not feeling well” most of the time, and they may develop a number of complications, including osteoporosis, anemia, gastrointestinal cancers, non-Hodgkins lymphoma, and mnay more.

The only treatment for celiac disease currently is a strict, life-long, gluten-free diet.  Because the consumption of any gluten causes the exaggerated inflammatory reaction in the intestines and throughout the body, it is not safe for a person with celiac disease to even consume “just a little bit” of gluten.  This means their food must contain no wheat, wheat products (bulgur, durum flour, farina, semolina, spelt, kamut, graham flour), barley, or rye.  Additionally, oats are commonly cross-contaminated during the harvesting and manufacturing process, making them unsafe.  Mayo Clinic advises that individuals with gluten intolerances should avoid consuming and cross-contamination with the following items, unless labeled “gluten-free”:

  • Beer
  • Breads
  • Cakes/Pies
  • Candies
  • Cereals
  • Cookies
  • Crackers
  • Croutons
  • Food additives (malt flavoring, modified food starch)
  • French Fries
  • Gravies
  • Imitation meats or seafood
  • Matzo
  • Medications and vitamins
  • Pastas
  • Play dough
  • Processed lunch meats
  • Salad dressings
  • Sauces, including soy sauce
  • Seasoned rice mixes
  • Seasoned snack foods, including chips
  • Self-basting poultry
  • Soups and soup-bases
  • Vegetables in sauce

The above list can seem intimidating, especially when first diagnosed with celiac disease, but patients should remember that they still have options that they can enjoy without searching for a “gluten-free” label. “Safe foods” includes

  • Beans
  • Corn/Cornmeal
  • Eggs, fresh
  • Flax
  • Fruits
  • Hominy
  • Rice/Soy/Potato/Corn Fours
  • Juices
  • Meats/Poultry/Fish
    • (NOT processed, imitation, breaded, marinated)
  •  Milk
  • Millet
  • Nuts/Seeds
  • Quinoa
  • Rice
  • Soy
  • Tapioca
  • Vegetables

While the list of things to avoid does include medications and play dough, it is important to note that an item with gluten must be consumed or ingested for it to be capable of producing intestinal inflammation.  This means that you can still handle play dough if you have celiac disease; you will be safe as long as you do not eat it.  In regards to medications that contain gluten, most do not.  And if they do, it is always in the form of inactive ingredients used to sweeten, bind, suspend, or “bulk-up” the drug product.  Your pharmacist can check if your medication is gluten free.  She/he can examine the list of inactive ingredients for “red-flag” ingredients and then contact the products manufacturer to verify whether the product is gluten free.

Resources:

Mangione, R.A., Jay, L., & Wisner, J.H. (March 7, 2011). Celiac Disease Training for Pharmacists. [PowerPoint slides]. Retrieved from http://www.proce.com/celiac-disease.html

August 2, 2011. Gluten-free diet: What’s allowed, what’s not. Retrieved from http://www.mayoclinic.com/health/gluten-free-diet/my01140

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